Need Help With 300 Word Discussion Post In-Text -Citation and Reference

Topic: Assessing Spirituality – The Relationship between Spirituality and Mental Health

Read the “Assessing Spirituality – The Relationship between Spirituality and Mental Health” article found in the Reading & Study folder for Module/Week 7.

In this quantitative study, the authors attempted to investigate the possible relationship between two spirituality variables (religious coping styles and spiritual well-being) and two psychological variables (anxiety and depression). Also studied were differences between those who self-disclosed a spiritual/religious identity and those who did not. Their data analysis concluded that individuals who reported a high use of religious coping styles also reported high levels of spiritual well-being.

The authors felt a limitation of their study was in defining ‘spirituality.’ State how that can be an obstacle in doing religious counseling.

The authors state, “Spiritual well-being can clearly incorporate God into ones’ life while also incorporating self-reliance.” Is this not a seeming contradiction? Give your thoughts on this.

Journal of Spirituality in Mental Health, 15:

107

–122, 2013
Copyright © Taylor & Francis Group, LLC
ISSN: 1934-9637 print/1934-9645 online
DOI: 10.1080/19349637.2013.776442

Assessing Spirituality: The Relationship
Between Spirituality and Mental Health

DAVID R. BROWN
Department of Behavioral Sciences, Cincinnati Christian University,

Cincinnati, Ohio, USA

JAMIE S. CARNEY
Department of Special Education, Rehabilitation, Counseling/School Psychology,

Auburn University, Auburn, Alabama, USA

MARK S. PARRISH
Department of Counseling and Educational Psychology, University of West Georgia,

Carrollton, Georgia, USA

JOHN L. KLEM
Department of Rehabilitation and Counseling, University of Wisconsin-Stout,

Menomonie, Wisconsin, USA

This research study investigated the possible relationship between
two spirituality variables (religious coping styles and spiritual
well-being) and two psychological variables (anxiety and
depression). Also studied were differences between those who
self-disclosed a spiritual/religious identify and those who did not.
Although a relationship was not noted between religious coping
styles and the psychological variables, significance was reported
in the relationship between spiritual well-being and both psy-
chological variables. Overall, this study finds that individuals
reporting higher levels of religiosity and spiritual well-being may
also experience a reduction in mental and emotional illness.

KEYWORDS spirituality, religiosity, anxiety, depression

Over the past few decades, spirituality has become an increasingly impor-
tant consideration in the mental health profession (Richards & Bergin, 2005;
Young, Wiggins-Frame, & Cashwell, 2007). This has included an emphasis

Address correspondence to David R. Brown, Department of Behavioral Sciences,
Cincinnati Christian University, Cincinnati, OH 45204. E-mail: david.brown@ccuniversity.edu

107

108 D. R. Brown et al.

and awareness of the importance of integrating spirituality and religion
within the counseling process (Parker, 2011; Seybold & Hill, 2001). The inte-
gration of spirituality into the counseling process is reflective of recognition
that spirituality can be beneficial to client welfare (Koenig, 2010; Miller &
Thoresen, 2003; Seybold & Hill, 2001). Moreover, there is significant evi-
dence that spirituality may be related to or positively impact overall mental
health or well-being (Hodges, 2002; Townsend, Kladder, Ayele, & Mulligan,
2002). This point is reflected in the growing body of research examining
the physical, emotional, and psychological effects of spirituality and religios-
ity (Hayman et al., 2007). For many individuals, spirituality and religion are
central and foundational aspects of their lives and their well-being, and thus
critical elements of the counseling process and interpersonal dynamic (Miller
& Thoresen, 2003; Parker, 2011; Seybold & Hill, 2001).

As previously noted, evidence suggests that spirituality may be linked
to physical health and well-being (Hodges, 2002; Townsend et al., 2002),
and that spirituality is a significant component of holistic wellness (Myers
& Williard, 2003). From a mental health perspective, religion and spiritual-
ity may be involved in how individuals and groups make decisions, solve
problems, and cope with life experiences; all of these activities incorporate
spiritual themes and subsequently can correspond to overall improved men-
tal health (Thurston, 1999; Pargament et al., 1988). In addition, spirituality
may be an asset or a coping strategy for dealing with negative life events, as
well as with psychological concerns (Koenig, 2010; Pargament et al., 1988);
for example, Hayman et al. (2007) reported that spirituality helped buffer the
negative effect of stress on self-esteem. There are also indicators that spiritu-
ality may relate to how an individual deals with or is affected by depression
(Srinivasan, Cohen, & Parikh, 2003; Westgate, 1996) and anxiety (Graham,
Furr, Flowers, & Burke, 2001).

LIMITATIONS OF CURRENT RESEARCH IN SPIRITUALITY
AND RELIGIOSITY

Although research has supported that spirituality is linked to both positive
physical health (Miller & Thoresen, 2003; Townsend et al., 2002) and pos-
itive mental health (Koenig, 2010; Hayman et al., 2007), the same research
also notes a number of complicating factors in studying spirituality and reli-
giosity. A review of literature reveals that similar limitations are noted in
many research studies, the most common problem being the definition of
spirituality. When questioning if spirituality can be measured, Oakes and
Raphel (2008) noted that a common concern is defining the constructs: “these
definitional problems make it difficult to know what a measure of spiritu-
ality actually assesses” (p. 243). This problem in defining spirituality echoes
Speck’s (2005) concerns regarding the inherent difficulty in determining a

Assessment of Spirituality and Mental Health 109

consensual definition of spirituality because of its epistemological nature.
Further, Seybold and Hill (2003) suggested that the inconsistencies in defin-
ing spirituality and religiosity have resulted in an ambiguous nature of
research findings, which then leads to conflicted reporting when linking
research outcomes to the mental and physical health issues being treated.

Other noted limitations in studying spirituality and religiosity are that
quantitative measures may not fully assess the subjective nature of spirituality
(Moberg, 2002) and that a majority of spiritually related assessment instru-
ments are developed from a Judeo-Christian perspective (Stanard, Sandhu,
& Painter, 2000). Moberg (2002) suggested that qualitative assessments may
provide more useful and specific information about an individual’s spiritual-
ity than a quantitative measure, as individual responses may better express
spiritual needs and experiences. As noted by Stanard et al. (2000), many
measures of spirituality and religiosity also lack normative information, thus
limiting their usefulness in clinical settings. Because a lack of normative
information inhibits the ability to generalize assessed results, Moberg’s (2002)
suggestion for a qualitative assessment of spirituality reflects an understand-
ing of the individualistic nature of spiritual experience and expressions, as
well as articulating the difficulty in even developing a normative under-
standing of spirituality. Miller and Thoresen (2003) stated that spirituality
and religiosity are best described as latent constructs, which are complex and
multidimensional variables. Therefore, such complexity in a construct implies
that no single assessment instrument can adequately capture its meaning.

Research in spirituality and religiosity has attempted to address this com-
plexity through the development of a multitude of assessment instruments.
Hill and Hood (1999) published a review of 125 spirituality/religiosity assess-
ment instruments, which were placed into 17 categories; each designed to
assess a different construct of spirituality and religiosity. These 17 categories
were defined as (a) religious beliefs and practices, (b) religious attitudes, (c)
religious orientation, (d) religious development, (e) religious commitment
and involvement, (f) religious experience, (g) religious/moral values or per-
sonal characteristics, (h) multidimensional religiousness, (i) religious coping
and problem solving, (j) spirituality and mysticism, (k) God concept, (l) reli-
gious fundamentalism, (m) death/afterlife, (n) divine intervention/religious
attribution, (o) forgiveness, (p) institutional religion, and (q) related con-
structs. Unfortunately, as noted by Stanard et al. (2000), most of the
assessment instruments reviewed by Hill and Hood (1999) suffered from
a lack of normalizing data, questionable design, and most were devel-
oped from a Judeo-Christian perspective. Some instruments, although initially
developed from a Judeo-Christian view, have shown promise through the
development of normalized information, validation through repeated use
within numerous research studies, and refinement of nonspecific religious
vocabulary. Assessment instruments, such as the Spiritual Well-Being Scale
(Ellison, 1983; Paloutzian & Ellison, 1982) and the Religious Problem-Solving

110 D. R. Brown et al.

Scale (Pargament et al., 1988), have demonstrated high levels of validity and
reliability, thus suggesting greater utility in research and practice.

The increase of interest in the study of spirituality and religiosity
has resulted in the development and improvement of assessment instru-
ments designed to evaluate various constructs of spirituality and religiosity.
Research studies, such as Hayman et al. (2007) and Davis, Kerr, and
Robinson-Kurpius (2003), used assessment instruments designed to measure
faith maturity and levels of spiritual well-being and religious orientation,
respectively, related to various mental health concerns. Davis et al.’s (2003)
study reported that “greater spiritual well-being predicted lower trait anxi-
ety among at-risk adolescents” (p. 361), although they did caution against
over-generalization of these results. Similarly, Hayman et al.’s (2007) study
reported that higher levels faith maturity correlated with higher levels of
self-esteem and lower levels of stress and body-image concerns. Although
further study in the areas of spirituality and religiosity is recommended, suffi-
cient evidence has already been collected to demonstrate correlations among
spirituality and religiosity with both mental and physical health. It appears
that further research should focus in refining an understanding of various
spiritual constructs with physical and mental health, as well as determining
how to resolve the deficiencies in the qualitative assessment of spirituality
and religiosity, as noted previously.

THE CURRENT STUDY

The current study was designed to evaluate the relationship of spiritual
well-being and religious problem-solving with anxiety and depression. The
selected spiritual constructs were partially determined through the selec-
tion of well-validated instruments designed to evaluate spirituality. Because
of noted limitations with spirituality assessment instruments, the authors
resolved to carefully select assessment instruments that have demonstrated
fewer such limitations; a discussion of these instruments is provided below.
Furthermore, because anxiety and depression are currently understood as
two of the most common psychological concerns throughout the world
(Seligman & Reichenberg, 2007), they presented as common, personal
characteristics that could be present in a nonclinical sample population.

Because literature has suggested that the relationship between men-
tal health and spirituality is complex (Miller & Thoresen, 2003; Seybold &
Hill, 2001), it is important to note that understanding this relationship is
made even more complex when one considers the overlapping and dif-
fering constructs and definitions of religiosity and spirituality, as noted by
Moberg (2002) and Richards, Bartz, and O’Grady (2009). For the purposes
of this study, spirituality will be defined as a sense of connectedness to a
higher power and openness to the infinite beyond human existence and

Assessment of Spirituality and Mental Health 111

experience (Burke et al., 1999). Religion (or religiosity) will be defined
as “an institutionalized set of beliefs and practices by which groups and
individuals relate to the ultimate” (Burke et al., 1999, p. 252). Inherent in
these definitions is an understanding that both religion and spirituality are
complex constructs, to address this issue the current study focused on two
specific aspects of spiritual and religious identity: religious problem-solving
(specifically religious coping styles as they correspond to one’s relation-
ship with God in a passive, collaborative, or self-initiating approach, as
developed by Pargament et al., 1988) and spiritual well-being. The latter
(spiritual well-being) consists of a global concept relating to one’s own
perception of spirituality and well-being, including one’s sense of quality
of life (Ellison, 1983; Paloutzian & Ellison, 1982). Furthermore, it was the
intent of this research study to compare across the spirituality measures to
determine which demonstrated a more significant relationship with the mea-
sures of mental health used in this study (Beck Anxiety Inventory and Beck
Depression Inventory-II). In addition, this study will address any differences
noted within the sample population, as some participants were recruited
from a private, religiously affiliated university, and other participants were
recruited from a public university. The findings of this study could provide
critical information for counseling professionals about this relationship, as
well as how it relates to psychological and mental health concerns.

METHOD

Participants and Sampling

Both undergraduate and graduate students from two universities were
recruited as a convenience sample to participate in this study: one university
is a large, public institution in the Southeast (Southeastern), and the second
university is a small, private, religiously affiliated university located in the
Midwest (Midwestern). All participants were recruited from both undergradu-
ate and graduate courses and were offered extra credit to complete an assess-
ment packet. A total of 150 surveys were distributed at the end of a class ses-
sion and collected the following class session; in all, 121 survey packets were
returned (response rate of 81.3%; there was no follow-up). All responses
were anonymous. There were 30 male and 91 female participants. Participant
ages ranged from 19 to 56 years (M = 24.50 years). Ethnic diversity among
participants was slight as 82% self-reported as Caucasian, 13.1% self-reported
as African-American, and 4% self-reported with other distinct ethnicities.
Furthermore, religious diversity was low; 96.2% (n = 25) of the Midwestern
participants reported to be Christian (3.8% [n = 1] reported to be Messianic
Jew) or of a Christian denomination, and 90.6% (n = 87) Southeastern par-
ticipants reported to be Christian or of a Christian denomination. Other
Southeastern participants reported as Agnostic (4.2%, n = 4), Gnostic (1.0%,
n = 1), Jewish (2.1%, n = 2), and Seventh-Day Adventist (1.0%, n = 1).

112 D. R. Brown et al.

Participants completed a packet consisting of a demographic ques-
tionnaire and four assessment instruments. The demographic questionnaire
requested grouping data such as age, ethnicity, gender, religious/spiritual
affiliation, and the use of the word “God” in their spiritual/religious affil-
iation. To counterbalance the presentation of measures and not affect the
participant responses, the order of documents placed in half of the survey
envelope packets contained documents in a different order.

Measures

The Religious Problem-Solving Scale (RPSS) was used to measure religious
coping and problem-solving styles. This scale was designed by Pargament
et al. (1988). Consisting of three subscales (Self-Directing, Collaborative, and
Deferring), the RPSS contains 36 items on a 5-point Likert scale (1 = never,
2 = occasionally, 3 = fairly often, 4 = very often, and 5 = always) in which
item responses indicate how often the individual engages in an activity.
According to Thurston (1999), reliability and validity are reportedly strong:
Collaborative (r = .94, α = .93), .94 Self-Directing (r = .94, α = .91), and
Deferring (r = .91, α = .89). Test-retest reliability returned promising relia-
bility estimates: α = .93 (Collaborative), α = .94 (Self-Directing), and α = .87
(Deferring). According to Pargament et al. (1988), in respect to measures of
religiousness, the Self-Directing subscale correlated to a significantly negative
relationship with a Higher Power, whereas the Collaborative and Deferring
exhibited a positive relationship.

The Spiritual Well-Being Scale (SWBS; Ellison, 1983; Paloutzian &
Ellison, 1982) was designed to provide a global measure of a respondent’s
quality of life and one’s perception of spiritual well-being (Boivin, Kirby,
Underwood, & Silva, 1999). The instrument is constructed of two subscales:
religious well-being (Religious) and existential well-being (Existential), as
well as an overall score of spiritual well-being (SWB). The SWBS is a 20-item
assessment answered on a 6-point Likert-type scale (1 = strongly agree to 6 =
strongly disagree), where reliability and validity appear to be high (Stanard
et al., 2000): Religious (r = .96, α = .96), Existential (r = .86, α = .78), and
SWB (r = .93, α = .89), with a slight correlation between the two subscales
(r = .32), a high correlation between SWB and the Religious subscale (r =
.90), and a moderate correlation between SWB and the Existential subscale
(r = .59). However, the test-retest reliability coefficients with four samples on
a 1-, 4-, 6-, and 10-week interval resulted in high reliability; the SWB global
scale ranged from .82 to .99, the Religious subscale ranged from .88 to .99,
and the Existential subscale ranged from .73 to .98 (Paloutzian & Ellison,
1991). Internal consistency reliability coefficients for the two subscales and
the global scale reported results for SWB ranging from .89 to .94, results for
the Religious subscale ranging from .82 to .94, and results for the Existential
subscale ranging from .78 to .86.

Assessment of Spirituality and Mental Health 113

The Beck Anxiety Inventory (BAI; Beck, Epstein, Brown, & Steer, 1988)
was used in this study to measure symptom levels of anxiety. The BAI
was created from three existing anxiety assessments to more accurately
discriminate anxiety-related diagnoses from non-anxiety-related diagnoses.
Consisting of 21 items, the BAI is answered on a 4-point Likert scale (0 =
not at all to 3 = severely; I could barely stand it) to indicate severity of anxi-
ety symptoms. Beck et al. (1988) reported that the BAI displayed high levels
of internal consistency (α = .92). Furthermore, Dowd and Waller (1998)
reported that internal consistency reliability coefficients ranged between
.85 and .94 and test-retest reliability over one week resulted in a coefficient
of .75.

The Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 1996)
was utilized in this study to evaluate levels of depression in participants. The
BDI-II consists of 21 items, each scored on a 4-point Likert scale (0 = not
present to 3 = severe). Beck et al. (1996) reported that the BDI-II exhibits
high Cronbach’s alphas: outpatients (α = .92) and college students (α = .93).
Internal consistency reliability was measured using corrected item-total cor-
relations for both the clinical (range = .39 to .70) and convenience (range
= .27 to .74) samples. The test-retest reliability resulted in a reliability coef-
ficient of α = .93. The BDI-II also correlated well with the BAI with a small
subject sample (n = 297; r = .60).

RESULTS

Because the spirituality assessments were developed from a Judeo-Christian
perspective, participants were asked to respond to the following on the
demographics questionnaire: “Does your spiritual/religious identity use
the word ‘God’?” One hundred percent of participants indicated that the
word “God” is used in their spiritual/religious identity. Familiarity with the
word “God” clearly did not invalidate the results. Analysis of assessment
results reported that Midwestern participants reported higher scores on the
Collaborative (M = 43.88; SD = 7.039; α = .88) and Deferring (M = 30.15;
SD = 7.358; α = .83) subscale than Southeastern participants (M = 37.31;
SD = 12.531; α = .96 and M = 29.25; SD = 10.595; α = .93, respectively).
Conversely, the Southeastern participants reported higher scores on the Self-
Directing subscale (M = 25.32; SD = 12.015; α = .96) than the Midwestern
participant (M = 21.96; SD = 6.109; α = .87). Overall, the mean responses on
the Collaborative (M = 38.72, SD = 11.861, α = .96), Deferring (M = 29.45,
SD = 9.967, α = .92), and Self-Directing (M = 24.60, SD = 11.080, α =
.96) subscales suggested that participants were more likely to use a collabo-
rative relationship with God to address problems and cope with negative life
experiences, as well as demonstrating strong reliability factors. Overall mean
results for the Religious (M = 52.59, SD = 10.061, α = .95) and Existential

114 D. R. Brown et al.

(M = 50.40, SD = 6.361, α = .82) subscales indicated that participants
endorsed strong religious well-being, as well as a high degree of existential
well-being. Specifically, the Midwestern participants reported higher levels
of spiritual well-being on both the Existential subscale (M = 51.15; SD =
5.767; α = .78) and the Religious subscale (M = 56.73; SD = 6.625; α =
.85) than the Southeastern participants (M = 50.20; SD = 6.528; α = .83
[Existential]; M = 51.45; SD = 10.824; α = .96 [Religious]). These findings
imply that the participants perceive a robust sense of satisfaction in one’s
relationship with God and a solid identity with spiritual/religious practices,
as well as a high level of satisfaction with one’s life. Additionally, overall
mean responses from the BDI-II (M = 7.21, SD = 6.275, α = .88) and the
BAI (M = 6.93, SD = 6.263, α = .87) reveal that the participants in this study
did not positively endorse many symptoms of depression or anxiety, respec-
tively. Table 1 provides information regarding the overall Pearson correlation
coefficients.

To determine the relationship between spirituality and mental health,
a multiple regression was used. Table 2 provides a summary of the multi-
ple regression analysis, demonstrating the independent variables (spirituality
subscales) used within the full and restricted models. The coefficients of
determination (R2 = .236) indicated that in the full model, all five spirituality
subscales significantly accounted for approximately 23.6% of the relationship
with the BDI-II, F (5,115) = 7.113, and approximately 15.4% (R2 = .154) of
the relationship with the BAI, F (5,115) = 4.171. Additionally, the effect sizes

TABLE 1 Pearson Correlations between the Spirituality Subscales and Mental Health
Inventories

Deferring Self-Directing Existential Religious BAI BDI-II

Collaborative .748∗∗∗ −.698∗∗∗ .358∗∗∗ .760∗∗∗ −.092 −.077
Deferring — −.586∗∗∗ .283∗∗ .605∗∗∗ −.001 −.012
Self-Directing — −.348∗∗∗ −.809∗∗∗ .117∗ .196
Existential — .489∗∗∗ −.299∗∗∗ −.448∗∗∗
Religious — −.041 −.212∗

∗p < .05. ∗∗p < .01. ∗∗∗p < .001.

TABLE 2 Multiple Regression Model Summary

Regression model IV R R2 F F �

Full models
BDI-II 5 .486 .236 7.113∗∗∗ —
BAI 5 .392 .154 4.171∗ —

Restricted models
BDI-II 1 .448 .201 29.848∗∗∗ 2.136
BAI 3 .369 .136 6.155∗ .625

∗p < .05. ∗∗p < .01. ∗∗∗p < .001.

Assessment of Spirituality and Mental Health 115

were relatively small at f 2 = .309 (BDI-II) and f 2 = .182 (BAI). These mod-
els, however, were further restricted to the spirituality subscales that made a
significant contribution toward the relationship with mental health.

For the BDI-II, the model was restricted to a single spirituality subscale
(Existential) and accounted for 20.1%, R2 = .201; f 2 = .252; F (1,120) =
29.848, of the relationship. For the BAI, the restricted model retained three
subscales (Existential, Self-Directing, and Religious) and accounted for 13.6%,
R2 = .136; f 2 = .157, F (1,118) = 6.155. The R2 values from the full and
restricted models were not statistically significant for the BDI-II (p = .146) or
the BAI (p = .431), indicating that the restricted models did not significantly
decrease the effect size by removing variables. In summary, the restricted
regression model contains the spirituality subscales that significantly con-
tributed to the relationship with the mental health measures. The primary
findings from the results suggests that existential well-being is a significant
factor in lower levels of anxiety and depression, and that religious coping
styles do not appear to factor into lowered levels of anxiety and depression.

Table 3 summarizes the effects of each spirituality subscale in the
full and restricted regression models. As expected by the researchers, the
Existential subscale provided the greatest predictor variable in both the
BDI-II (β = −.448) and the BAI (β = −.299), indicating a strong inverse
relationship between experiencing meaning and purpose in one’s life and
experiencing symptoms of anxiety and depression. Although not found with
the BDI-II, the Religious and Self-Directing subscales loaded with smaller
effect sizes with the BAI. More specifically, a moderate positive predictor
value (β = .120) was found for the Self-Directing subscale and a smaller
negative predictor value (β = −.041) was found for the Religious subscale.
These results appear to indicate having a meaningful, purposeful relationship

TABLE 3 Multiple Regressions with the Spirituality Measures and the Mental Health
Inventories

BDI-II BAI

Regression model β r β r

Full model
Collaborative .125 −.077 −.219 −.094
Deferring .148 −.012 .171 −.001
Self-Directing .205 .196 .301 .120∗

Existential −.460 −.448∗∗∗ −.387 −.299∗∗∗
Religious −.006 −.212 .456 −.041∗∗

Restricted model
Existential −.448 −.448∗∗∗ −.387 −.299∗∗∗
Self-Directing — — .306 .120∗

Religious — — .396 −.041∗
∗p < .05. ∗∗p < .01. ∗∗∗p < .001.

116 D. R. Brown et al.

with God or a Higher Power is the most significant factor in reduced levels
of anxiety and depression.

A multivariate test of significance found a Wilks’ lambda of .843 (p =
.030) with the BAI. This value indicated a significant difference between the
BAI and spirituality subscales; the observed power (.883) denoted these val-
ues were likely a true effect and did not result from chance. Additionally,
a Wilks’ Lambda of .700 (p < .001) with the BDI-II indicating a significant difference between the BDI-II and the spirituality subscales. Also reporting a high observed power (.992), the effect between the BDI-II and the spiritu- ality subscales was likely a true effect. Therefore, for the participants in this study, these results appear to be an accurate representation of the inverse relationship between spiritual well-being and mental health concerns.

A final consideration for this study concerned the response differences
between the two sample populations. As previously noted, the Midwestern
participant group was recruited from a small, private, religiously-affiliated
university, whereas the Southeastern participants were recruited from a
large, public university. As a primary critique of the spirituality assessment
instruments is that past research participants were recruited from religiously
affiliated universities or church groups (Boivin et al., 1999; Thurston, 1999), it
was of interest to determine if differences exist between the two participant
groups in this study. A t-test analysis was conducted and two subscales indi-
cated group differences: Collaborative (t = 3.49, p < .001) and Religious (t = 3.64, p < .001). Table 4 provides results for all spirituality subscales. Because the t-test analysis reported significant differences on only two of the five spirituality subscales, the data was evaluated as a single participant group.

DISCUSSION

Although a generalization of these research results is limited due to the
homogeneity of ethnicity and religiosity, the findings of this study do suggest

TABLE 4 T -Test Analysis with the Spirituality Subscales and Mental Health Instruments

Midwestern participants Southeastern participants

Subscale n M SD n M SD t p

Collaborative 26 43.88 7.039 95 37.31 12.531 3.488 .001a

Deferring 26 30.15 7.358 95 29.25 10.595 .499 .620
Self-Directing 26 21.96 6.109 95 25.32 12.015 −1.951 .054
Existential 26 51.15 5.767 95 50.20 6.528 .676 .500
Religious 26 56.73 4.754 95 51.45 10.824 3.640 .001a

BAI 26 5.62 4.900 96 7.29 6.558 −1.213 .227
BDI-II 26 7.96 8.388 96 7.01 5.607 .546 .589

aUsing a Bonferroni-adjusted alpha level of .05/7 = .007.

Assessment of Spirituality and Mental Health 117

that a relationship exists between the symptoms of anxiety and depression
and level of spiritual well-being. Not surprisingly, the findings also sug-
gest that the spirituality constructs measured in this study were related, as
indicated in Table 3; the spiritual well-being subscales and religious cop-
ing subscales were significantly correlated. Specifically, the results of this
study indicates that individuals who reported a high use of religious coping
styles also reported high levels of spiritual well-being. Because the mean
values of all spirituality subscales are relatively high and are highly corre-
lated, these results may indicate multicollinearity among the independent
variables (spirituality subscales), or even a mediating variable. This idea has
been supported in literature: it has been suggested that spirituality assess-
ment instruments may measure similar constructs (Miller & Thoresen, 2003;
Phillips, Pargament, Lynn, & Crossley, 2004); the findings in this study sug-
gest that the spirituality subscales do not adequately discriminate among the
constructs they measure. It should be noted that two characteristics of the
study participants may have influenced these overall findings: a large major-
ity of the participants reported a relatively high level of spiritual well-being,
as well as a high level of use of religious coping styles. This homogenous
demographic characteristic of the sample may limit the generalized appli-
cation of these findings. However, group differences need to be viewed
in relation to differences between levels of religious affiliation within the
sample. This suggests the need for further assessment in this area.

Surprisingly, the results reported that participants who indicated
a greater desire to work together with God to resolve a problem
(Collaborative) also strongly endorsed a belief that they address problems
without any intervention from God (Self-Directing). While this result may
initially appear contradictory, it may also suggest that the study participants
are articulating a strong sense of spiritual well-being, as well as maintain-
ing a strong sense of self-confidence in their ability to address negative life
events; however, this does not diminish their emphasis on relying upon
themselves. Spiritual well-being can clearly incorporate God into ones’ life
while also incorporating self-reliance. Because many participants were tradi-
tional undergraduate students, it is important to note that Ma (2003) proposes
that during the stresses and uncertainty found during the college years, stu-
dents might feel supported by, but not totally rely upon, spiritual guidance.
Students may not feel the need to turn to God with all problems, just the
concerns that are significant or overwhelming. Ma’s (2003) assertion could
explain this apparent contradiction of indicating both a collaborative and
self-directing relationship with God or a Higher Power.

Among the Religious Problem-Solving Scale subscales, only the Self-
Directing subscale demonstrated a significant positive correlation to the
depression, as measured by the BDI-II (see Table 1); this finding suggests
that the participants who reported higher levels of depressive symptoms also
reported using a self-initiating, self-reliant approach to coping with negative

118 D. R. Brown et al.

life events. Two possible explanations may be that less reliance upon a
higher power may increase the possibility of feeling alone and unsupported,
thus leading to increased symptoms of depression (Phillips et al., 2004)
or that higher levels of depression may also indicate a loss of hope, thus
preventing the individual from utilizing spiritual and/or religious resources
(Hodges, 2002).

The findings also demonstrated that participants who reported higher
levels of existential well-being also reported fewer or less intense symp-
toms of depression. This result parallels the previously discussed findings
and those reported in previous research; specifically, individuals reporting a
higher level of involvement in spiritual and/or religious activities also report
decreased symptoms of depression, especially as it relates to life satisfaction
and finding meaning in life (Wachholtz & Pargament, 2005; Young, Cashwell,
& Shcherbakova, 2000). Additionally, the results suggested that individuals
reporting lower levels of depressive symptoms endorsed a higher level of
religious well-being. Much like the Existential subscale, these results may
indicate that persons experiencing fewer symptoms of depression may per-
ceive a closer relationship with God as expressed through religious activity.
These results also support research reporting that religious activity may alle-
viate symptoms of depression (Hodges, 2002; Wachholtz & Pargament, 2005).
These findings, however, should be viewed cautiously as the majority of
participants reported relatively low levels of depressive symptoms and high
levels of religiosity. Even so, the results of this study appear to support previ-
ous research in mental health: engaging in spiritual and/or religious activities
may reduce or alleviate symptoms of depression.

These results should be considered relative to the results that indi-
cated participants who reported high levels of existential well-being also
reported lower levels of anxiety symptoms. This suggests that persons report-
ing higher levels of existential well-being may be better equipped to handle
stressful and anxiety-producing situations. Furthermore, this correlation may
be bi-directional, meaning that a lack of anxiety could also encourage an
increase in existential well-being and vice-versa. Similarly, other studies have
demonstrated an inverse relationship between spirituality and mental health
concerns (Berry & York, 2011; Graham et al., 2001). Specifically, previous
research has suggested that persons with a high level of spiritual well-being
also report lower levels of mental health concerns. Although not statistically
significant, the slight negative trend between the Beck Anxiety Inventory and
the Religious subscale is consistent with other research which has suggested
that persons engaging in spiritual and/or religious activities are more likely
to report fewer mental health concerns (Miller & Thoresen, 2003; Seybold
& Hill, 2001). Furthermore, Townsend et al. (2002) and McCorkle, Bohn,
Hughes, and Kim (2005) suggested that religious activity has demonstrated
positive results in the treatment of anxiety and other mental health issues.
Finally, these results indicated that the constructs measured by the spirituality

Assessment of Spirituality and Mental Health 119

assessments could explain a significant portion of the relationship between
anxiety and depression as measured by the BAI and the BDI-II, respectively.
These results parallel previous research (Graham et al., 2001; Wachholtz &
Pargament, 2005), which has also demonstrated a relationship between men-
tal health and spirituality. Overall, the findings of the current study and this
previous research help support the importance of addressing and integrat-
ing spirituality and/or religiosity into the treatment of persons suffering from
physical, emotional, or mental illness. As discussed by others (Moberg, 2002;
Oakes & Raphel, 2008; Van Asselt & Senstock, 2009), this should be done
with respect to, and with appreciation of the individual’s personal religious
and spiritual identity.

In summary, this study suggests that individuals with higher levels of
existential well-being are also more likely to report lower levels of anx-
iety and depression; a finding that is supported by a variety of research
studies (Baetz, Bowen, Jones, & Koru-Sengul, 2006; Graham et al., 2001;
Wachholtz & Pargament, 2005). Moreover, existential well-being may corre-
spond to spirituality and mental health and individuals with a higher degree
of religious well-being may be more likely to report depression. This study
also suggests that individuals who participate in religious activities and/or
are seeking a closer relationship with God or a Higher Power may have
fewer or less intense depressive symptoms. Overall, the findings of the study
suggest that individuals with greater levels of religiosity and spiritual well-
being may also experience an increased sense of well-being and a decrease
in mental, emotional, and physical illness.

Implications for Counselors and Counselor Education

Throughout the past few decades, many research studies have examined the
relationship between spirituality and mental health, joining with the sizable
research base that has focused upon the relationship between spirituality
and physical health (Miller & Thoresen, 2003; Powell, Shahabi, & Thoresen,
2003; Seybold & Hill, 2001). The results of the current study further extend
this research base to consider how spiritual well-being, specifically existen-
tial well-being and religious well-being, may correspond to mental health.
In particular, the findings supported the idea that spirituality and religious
well-being can contribute to mental health. This helps add to the ever-
growing call to train counselors to be prepared to integrate spirituality into
the counseling process. Furthermore, the results add to increasing support
for counselor training programs to consider how religion and spirituality
relate to the counseling process and to clients’ well-being. Based upon this
growing support, counselor education training programs should consider
how to incorporate training on these issues in counseling practice and in
counseling supervision. There is also evidence that a component of this
is helping counselors explore personal perceptions and beliefs about the

120 D. R. Brown et al.

role of spirituality and religious well-being, and how they can be explored
during counseling process. This is a critical element, for it has been sug-
gested that this process should rely on counselors being able to appreciate
an individual’s spiritual and religious identity versus attempting to “force”
their religious beliefs on a client (Oakes & Raphel, 2008; Van Asselt &
Senstock, 2009). An appropriate integration of counseling and spirituality
can only occur if the counselor has adequate training on the role of spiritual-
ity in counseling and the opportunity to examine his/her own attitudes and
beliefs.

Finally, many have asserted that there is clearly sufficient evidence to
support the need for counselors to understand the role of religion and spiri-
tuality in the lives of their clients (Koenig, 2010; Miller & Thoresen, 2003;
Seybold & Hill, 2001). A potential starting point in this process may be
extending research on the role of spirituality and religion in the counseling
process. Richmond (2004) has claimed that research concerning spirituality
has been a part of the counseling profession for well over a century; how-
ever, there remains a real need for additional research and study focused
on addressing the negative perceptions of spirituality and religiosity as
they relate to the counseling process (Miller & Thoresen, 2003; Seybold
& Hill, 2001). Moreover, this study highlights that spirituality and religious
well-being may have a significant influence on overall mental health. The
challenge of future research will be defining the specifics of this relation-
ship: is it preventative or simply a coping process? In addition, and even
more importantly, how can counselors integrate it, assess it, or use spirituality
in a manner that will empower the counseling process?

REFERENCES

Baetz, M., Bowen, R., Jones, G., & Koru-Sengul, T. (2006). How spiritual values and
worship attendance relate to psychiatric disorders in the Canadian population.
Canadian Journal of Psychiatry, 51, 654–661.

Beck, A. T., Epstein, N., Brown, G. K., & Steer, R. A. (1988). An inventory for
measuring clinical anxiety: Psychometric properties. Journal of Consulting and
Clinical Psychology, 56 , 893–897.

Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression
Inventory II . San Antonio, TX: Psychological Corporation.

Berry, D. M., & York, K. (2011). Depression and religiosity and/or spirituality in col-
lege: A longitudinal survey of students in the USA. Nursing and Health Sciences,
13, 76–83.

Boivin, M. J., Kirby, A. L., Underwood, L. K., & Silva, H. (1999). Spiritual Well-Being
Scale [Review of the Spiritual Well-Being Scale]. In P. C. Hill & R. W. Hood,
Jr. (Eds.), Measures of Religiosity (pp. 382–385). Birmingham, AL: Religious
Education Press.

Assessment of Spirituality and Mental Health 121

Burke, M. T., Hackney, H., Hudson, P., Miranti, J., Watts, G. A., & Epp, L. (1999).
Spirituality, religion, and CACREP curriculum standards. Journal of Counseling
and Development, 77 , 251–257.

Davis, T. L., Kerr, B. A., & Robinson-Kurpius, S. E. (2003). Meaning, purpose, and
religiosity in at-risk youth: The relationship between anxiety and spirituality.
Journal of Psychology and Theology, 31, 356–365.

Dowd, E. T., & Waller, N. G. (1998). Beck Anxiety Inventory [Review of the Beck
Anxiety Inventory]. In J. C. Impara & B. S. Plake (Eds.), The thirteenth mental
measurements yearbook. Lincoln, NE: University of Nebraska Press.

Ellison, C. W. (1983). Spiritual well-being: Conceptualization and measurement.
Journal of Psychology and Theology, 11, 330–340.

Graham, S., Furr, S., Flowers, C., & Burke, M. T. (2001). Religion and spirituality in
coping with stress. Counseling and Values, 46 , 2–13.

Hayman, J. W., Kurpius, S. R., Befort, C., Nicpon, M. F., Hull-Blanks, E., Sollenberger,
S., & Huser, L. (2007). Spirituality among college freshmen: Relationships to
self-esteem, body image, and stress. Counseling and Values, 52, 55–70.

Hill, P. C., & Hood, R. J., Jr. (Eds.). (1999). Measures of religiosity. Birmingham, AL:
Religious Education Press.

Hodges, S. (2002). Mental health, depression, and dimensions of spirituality and
religion. Journal of Adult Development, 9, 109–115.

Koenig, H. G. (2010). Spirituality and mental health. International Journal of Applied
Psychoanalytic Studies, 7 , 116–122. doi:10.1002/aps.239

Ma, S. Y. (2003). The Christian college experience and the development of spirituality
among students. Christian Higher Education, 2, 321–339.

McCorkle, B. H., Bohn, C., Hughes, T., & Kim, D. (2005). “Sacred moments”: Social
anxiety in a larger perspective. Mental Health, Religion and Culture, 8, 227–238.

Miller, W. R., & Thoresen, C. E. (2003). Spirituality, religion, and health: An emerging
research field. American Psychologist, 58, 24–35.

Moberg, D. O. (2002). Assessing and measuring spirituality: Confronting dilemmas
of universal and particular evaluative criteria. Journal of Adult Development, 9,
47–60.

Myers, J. E., & Williard, K. (2003). Integrating spirituality into counselor preparation:
A developmental, wellness approach. Counseling and Values, 47 , 142–155.

Oakes, K. E., & Raphel, M. M. (2008). Spiritual assessment in counseling: Methods
and practice. Counseling and Values, 52, 240–252.

Paloutzian, R. F., & Ellison, C. W. (1982). Loneliness, spiritual well-being and quality
of life. In L. A. Peplau & D. Perlman (Eds.), Loneliness: A sourcebook of current
theory, research and therapy (pp. 224–237). New York, NY: Wiley Interscience.

Paloutzian, R. F., & Ellison, C. W. (1991). Manual for the Spiritual Well-Being Scale.
Nyack, NY: Life Advance.

Pargament, K. I., Kennell, J., Hathaway, W., Grevengoed, N., Newman, J., & Jones, W.
(1988). Religion and problem-solving process: Three styles of coping. Journal
for the Scientific Study of Religion, 27 , 90–104.

Parker, S. (2011). Spirituality in counseling: A faith development perspective. Journal
of Counseling and Development, 89, 112–119.

Phillips, R. E., III, Pargament, K. I., Lynn, Q. K., & Crossley, C. D. (2004). Self-
directing religious coping: A deistic God, abandoning God, or no God at all?
Journal for the Scientific Study of Religion, 43, 409–418.

122 D. R. Brown et al.

Powell, L. H., Shahabi, L., & Thoresen, C. E. (2003). Religion and spirituality:
Linkages to physical health. American Psychologist, 58, 36–52.

Richards, P. S., Bartz, J. D., & O’Grady, K. A. (2009). Assessing religion and spirituality
in counseling: Some reflections and recommendations. Counseling and Values,
54, 65–79.

Richards, P. S., & Bergin, A. E. (2005). A spiritual strategy for counseling and
psychotherapy (2nd ed.). Washington, DC: American Psychological Association.

Richmond, L. J. (2004). Religion, spirituality, and health: A topic not so new [Letter
to the editor]. American Psychologist, 59, 52.

Seligman, L., & Reichenberg, L. W. (2007). Selecting effective treatments: A compre-
hensive, systematic guide to treating mental disorders (3rd ed.). San Francisco,
CA: Jossey-Bass.

Seybold, K. S., & Hill, P. C. (2001). The role of religion and spirituality in mental and
physical health. Current Directions in Psychological Science, 10, 21–24.

Speck, B. W. (2005). What is spirituality? New Directions for Teaching and Learning,
104, 3–13.

Srinivasan, J., Cohen, N. L., & Parikh, S. V. (2003). Patient attitudes regarding depres-
sion: Implications for psychoeducation. The Canadian Journal of Psychiatry,
48, 493–495.

Stanard, R. P., Sandhu, D. S., & Painter, L. C. (2000). Assessment of spirituality in
counseling. Journal of Counseling and Development, 78, 204–210.

Thurston, N. S. (1999). Religious Problem-Solving Scale [Review of the Religious
Problem-Solving Scale]. In P. C. Hill & R. W. Hood, Jr. (Eds.), Measures of
Religiosity (pp. 347–350). Birmingham, AL: Religious Education Press.

Townsend, M., Kladder, V., Ayele, H., & Mulligan, T. (2002). Systematic review
of clinical trials examining the effects of religion on health. Southern Medical
Journal, 95, 1429–1434.

Van Asselt, K. W., & Senstock, T. D. B. (2009). Influence of counselor spiritual-
ity and training on treatment focus and self-perceived competence. Journal of
Counseling and Development, 87 , 412–419.

Wachholtz, A. B., & Pargament, K. I. (2005). Is spirituality a critical ingredient of
medication? Comparing the effects of spiritual meditation, secular meditation,
and relaxation on spiritual, psychological, cardiac, and pain outcomes. Journal
of Behavioral Medicine, 28, 369–384.

Westgate, C. E. (1996). Spiritual wellness and depression. Journal of Counseling and
Development, 75, 26–35.

Young, J. S., Cashwell, C. S., & Shcherbakova, J. (2000). The moderating relationship
of spirituality on negative life events and psychological adjustment. Counseling
and Values, 45, 49–57.

Young, J. S., Wiggins-Frame, M., & Cashwell, C. S. (2007). Spirituality and counselor
competence: A national survey of American Counseling Association members.
Journal of Counseling and Development, 85, 47–52.

Copyright of Journal of Spirituality in Mental Health is the property of Taylor & Francis Ltd and its content

may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express

written permission. However, users may print, download, or email articles for individual use.